目的 探讨O型、RhD(+)孕妇血清中IgG亚类水平与新生儿溶血病(HDN)的关系.方法 筛选血清IgG抗A(B)效价≥64的O型、RhD(+)孕妇112例,采用ELISA法对其中69例发生HDN的母亲(A组)及其ABO-HDN患儿(B组)、43例有HDN风险但未发生HDN孕妇(C组)及其分娩的健康新生儿(D组)血清的IgG亚类进行定量分析,并与50例IgG抗A(B)效价正常的O型、RhD(+)孕妇(E组)所测相应结果进行对照.结果 A、C组不同IgG抗A(B)效价差异有统计学意义(P＜0.05);A组血清中IgG1、IgG3和IgG4的含量显著高于E组(P＜0.05),IgG1和IgG3的含量高于C组,差异有统计学意义(P＜0.05).C组与E组比较IgG1、IgG2和IgG3的含量差异无统计学意义(P＞0.05);B组血清中IgG1和IgG3的含量显著高于D组(P＜0.05);患儿血清中IgG各亚类构成与母体不完全一致,但均以IgG1为主,患儿体内IgG1比例(62.3%)高于母体(57.9%),差异无统计学意义(P>0.05).结论 ABO血型系统中,母体血清中IgG1和IgG3的含量,尤其是IgG1的含量与新生儿溶血病的发病密切相关,夫妇血型不合的O型血孕妇应定期检测IgG抗A(B)效价及IgG亚类水平.%Objective To investigate the relationship between the concentration of IgG isoforms in gravidas with 0 type, RhD( + )and the incidence of heamolytic disease of newborn ( HDN ). Methods 112 cases were included, which have a serum concentration of IgG anti A ( B ) ≥ 64,the serum concentration of IgG isoforms were tested by ELISA in 69 cases of mothers with HDN ( group A ) and their newborns ( group B ), 43 cases of gravidas who were healthy but under the risk of HDN ( group C ) and their newborns ( group D ), 50 cases of healthy gravidas with type 0, RhD ( + ) ( group E ) as normal control. Results There were significant differences of serum concentration of IgG isoforms between group A and C( P < 0. 05 ); the concentration of IgG, , IgG3 and IgG4 in group A was higher than that in group E ( P <0.05 ); the serum concentration of IgG, and IgGj in group A was higher than that in group C with statistical different P <0.05 ), there was no statistical significance of these data between group C and group E( P >0. 05 ). The serum concentration of IgG, and IgG2 in group B was obvious higher than that in group D( P <0.05 ). The proportion of IgG isoforms in infants'serum was different from their mothers, IgG, was much higher with 62. 3% in infants than 57. 9% in their mothers,but there was no difference( P >0.05). Conclusion The concentration of IgG, and IgG3, especially IgG, is positive correlated with the incidence of HDN. In ABO blood type system, the gravidas with 0 blood type need to test the concentration of IgG isoforms at regular intervals when blood type is incompatible to their husbands.
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